Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Abstract

OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS: The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

“…1 The most commonly identified risk factor for the childhood obstructive sleep apnea syndrome is adenotonsillar hypertrophy. Thus, the primary treatment is adenotonsillectomy, which accounts for more than 500,000 procedures annually in the United States alone.…”

Identificação de fatores de risco para apneia obstrutiva do sono após adenotonsilectomia: estudo piloto

“…As queixas mais frequentes elencadas pelos pais das crianças foram obstrução nasal, respiração oral e ronco, também concordando com os achados da literatura prévia 1,7,10,22 . O ronco é apontado como importante preditor clínico a suspeita da AOS em crianças 23,24 .…”

“…O ronco é apontado como importante preditor clínico a suspeita da AOS em crianças 23,24 . No presente estudo, o sintoma ronco esteve presente em toda a amostra, entretanto, ressalta-se que apenas o relato da sintomatologia não é eficaz para diagnosticar a AOS e diferenciar os graus de gravidade 1,20,21,23,24 . A grande variedade de manifestações clínicas da AOS e a subjetividade do quadro clínico relatado pelos familiares contribui para não-homogeneidade dos sintomas em cada faixa etária, mesmo quando a severidade da síndrome é semelhante 2,23,24 .…”

Poligrafía en niños con enfermedad neuromuscular

“…No obstante, dado el alto costo de su implementación, han sido desarrollados exámenes alternativos como la poligrafía (pG), la cual, ha mostrado tener un rendimiento diagnóstico aceptable en la población de interés [5][6][7] .…”